The practise of dentistry in Germany
Dr Markus Firla, dentist and quality management consultant, provides some insight into the current climate of dentistry in Germany and how it is set to change in the future.
Question: What are some of the current trends in practice management among dentists in Germany?
Dr Firla: German dentists running their own dental practices have had to cope with a range of problems caused by the restrictions imposed on dentistry by legal regulations and the dental field becoming more competitive in recent years. With regard to the business aspect, increasingly dentists are pursuing subspecialty disciplines, such as implantology, which is seen as the most profit-generating path. The serious debate with this is whether specializing in dental implants has a sound cost-value-ratio for every practitioner. Notwithstanding such worries, it is clear that running a dental practice has to be based on the same principles every other commercial enterprise has to pay attention to.
As for current trends in practice management, dentists are more and more aware of the need to ‘organize their organizations’. That is why it is no longer uncommon to find a practice manager taking care of all the in-office and external administrative tasks in a dental office.
Question: Do undergraduate curricula in Germany provide dental students with a good base for running their own practices (from a business and quality management aspect)?
Dr Firla: To the best of my knowledge, the undergraduate training in German dental schools do not feature any particular courses or seminars on how to successfully run their own dental offices. Of course, any dental school’s paramount obligation is to provide teach clinical skills and provide extensive knowledge to future dentists. However, being a skilled practitioner is only one aspect of the demands dentists are facing today. In addition, running one’s own dental practice profitably means is to understand that you sell dental services to patients and that therefore they are customers. Furthermore, today’s dentists are forced to be far more productive in terms of generating profits than their colleagues in previous generations. The costs of running a modern and fully equipped dental practice with a committed and qualified team have risen immensely over the last few years with – as far as Germany is concerned – steadily decreasing revenues making it difficult to remain in the black.
Question: There is a rumour in the dental industry that German dentists dislike using email and the internet. Is this true? If not, how has the internet influenced modern dentistry in Germany?
Dr Firla: Well, that’s absolutely true. Though more than 75% of German dental offices are said to have internet access, only a small percentage of practices takes advantage of digital communication and information technology. However, there is an increasing tendency among dentists to use this as a means of exchanging ideas with peers. In addition, the number of websites of dental practices has grown significantly. The dental boards and organisations now also offer postgraduate courses on an interactive e-learning basis.
There is also a rise in enewsletters sent to dental offices from companies and institutions which suggests that dentists recognise and accept the importance of being kept updated in this medium. Within the next five to eight years, I think any dental office without fully implemented digital communications and information technology is doomed.
Question: With your extensive experience in training dentists in areas such as quality management, what are the most frequently asked questions on this subject?
Dr Firla: In 1999 the German government ordered that quality management should be conducted in each dental practice. The most frequently asked questions at the time were: ‘Why for God’s sake do dentists need in-office quality management?’ and , ‘Will it be of any use to us?’.
Over the past three years, however, the mental attitude towards quality management has changed significantly among forward-thinking dentists. It has become general consensus in dental circles that quality management has always been a crucial part of delivering dental services, even though the summation of such procedures had not been particularly defined as ‘quality management’ before. So the willingness of my colleagues to implement quality management is growing steadily. In this context, the most frequently asked questions nowadays are: ‘Which quality management system is best suited for my practice?, ‘What’s the cost/benefit-ratio for conducting quality management?’ and a host of questions about how to adopt, implement and successfully conduct in-office quality management.
Question: What are some of the challenges facing dentists in Germany today?
Dr Firla: That’s a tough question. In my opinion, all the difficulties German dentists need to tackle emanate from a political environment that has not been benevolent to dentists or dentistry in general over the past 25 years. For instance, the “Gebührenordnung für Zahnärzte”, (the governmentally decreed scale of fees for private patients), has never been adjusted in terms of raising fees or expanding the set itemized services that can be charged, since it came into effect in 1988. In this context, the scales of fees for prosthetic and periodontal treatment for patients with coverage of a statutory health fund were reduced by 10-30% respectively three years ago.
Another big challenge will derive from plans by the majority of German political parties to amalgamate statutory health funds and private insurance. Even though this scenario will not be realized in the immediate future, it will eventually have a negative impact on the freedom of dental professionalism with increased bureaucracy and intensified administrative problems.
Question: What are the opportunities for dentists in Germany today?
Dr Firla: All the changes Germany’s healthcare system has been (and is still going) through have forced German dentists to consider themselves as businessmen and women. On the basis of this altered self-perception, dentists are increasingly pro-active, which has stimulated a creative atmosphere. It will be very interesting to watch German dentists elaborate on patient-oriented strategies for delivering dental services and how they will market those services.
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editorial@dental-learninghub.com
Markus Firla graduated from Münster Dental Faculty at Wilhelms University, Germany, in 1986 completing his Dr. med. dent. degree there the same year. Whilst practicing dentistry he has been a consultant for international dental manufacturers, a dental journalist for German and English dental publications, and advisor to many a dental colleague over the past 20 years. His efforts to aid the advancement of the dental profession resulted in several petty patents and two full patents, four contributions to textbooks on general dentistry and a manual on tooth shaping. In 1998 he founded ‘WeCoMeD GmbH – Consulting & Services’ to provide a basis for his lecturing on practice management and general dentistry. In 2003 his own practice has attained certification in ISO 9001:2000 (Requirements for Quality Management Systems) and in 2005 it complied with EPA-Dent (European Practice Assessment for Dentistry) standards. In 2006 he became involved in postgraduate education with the Dental Board of Lower Saxony in Hanover. 2008 has seen him both complete his official training to attain ‘visitor’ status in assisting dental practices to implement quality management systems consistent with the requirements of EPA-Dent and being appointed as member of the Editorial Advisory Board of DPREurope.
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Dr Markus Firla, dentist and quality management consultant, provides some insight into the current climate of dentistry in Germany and how it is set to change in the future.
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